Managing Complications in Pregnancy and Childbirth: - IAWG

P-92 Correcting uterine inversionHYDROSTATIC CORRECTION• Place the woman in deep Trendelenburg position (lower her headabout 0.5 metres below the level of the perineum).• Prepare a high-level disinfected douche system with large nozzleand long tubing (2 metres) and a warm water reservoir (3 to 5 L).Note: This can also be done using warmed normal saline and anordinary IV administration set.• Identify the posterior fornix. This is easily done in partial inversionwhen the inverted uterus is still in the vagina. In other cases, theposterior fornix is recognized by where the rugose vagina becomesthe smooth vagina.• Place the nozzle of the douche in the posterior fornix.• At the same time, with the other hand hold the labia sealed over thenozzle and use the forearm to support the nozzle.• Ask an assistant to start the douche with full pressure (raise thewater reservoir to at least 2 metres). Water will distend theposterior fornix of the vagina gradually so that it stretches. Thiscauses the circumference of the orifice to increase, relieves cervicalconstriction and results in correction of the inversion.MANUAL CORRECTION UNDER GENERAL ANAESTHESIA• If hydrostatic correction is not successful, try manualrepositioning under general anaesthesia using halothane.Halothane is recommended because it relaxes the uterus.• Grasp the inverted uterus and push it through the cervix in thedirection of the umbilicus to its normal anatomic position (FigP-52, page P-91). If the placenta is still attached, perform a manualremoval after correction.COMBINED ABDOMINAL-VAGINAL CORRECTIONAbdominal-vaginal correction under general anaesthesia may berequired if the above measures fail.• Review for indications.